title: Outbreak of Q fever, Florac, Southern France, Spring 2007.
abstract: BACKGROUND
  In May 2007, five patients with Q fever-like symptoms were reported in an agricultural educational center in the rural southern French town of Florac. An investigation was undertaken to identify the outbreak source and risk factors for infection, and to implement control measures.
  
  
  METHODS
  We undertook active case finding. Patients were defined as individuals with an unexplained fever of ≥38.5°C who lived in, worked in, or visited Florac between April 1 and June 30, 2007. Patients were confirmed by a positive Q fever serology test. A cross-sectional survey with a seroprevalence component was carried out in the educational center and surrounding area. A standardized questionnaire on known risk factors for the infection was used and serological testing was carried out on finger prick blood specimens from participants. The veterinary services investigated local herds within a 5-mile radius using polymerase chain reaction and serological tests.
  
  
  RESULTS
  One hundred twenty-two people were included in the cross-sectional survey. Eighteen serologically confirmed acute cases were identified, of whom 12 were from the educational center. The statistical analysis showed an independent association between acute infection and living or working near an area where manure had been spread (p = 0.0.042) and male gender (p = 0.022). Frequenting the educational center's canteen was also associated with infection (p = 0.008) among staff and students. The veterinary investigations identified 11 of the 26 tested flocks of goats and sheep as seropositive for Coxiella burnetii, including 2 ovine flocks located northwest of Florac that had high shedding levels of the bacterium.
  
  
  CONCLUSIONS
  The observed excess of cases of Q fever in Florac, an area endemic for this infection, in spring 2007 could be explained by an aerial transmission from infectious ovine flocks situated close to the town. All local herd owners were re-educated about the risks and prevention practices for Q fever.
authors.affiliation: Regional Epidemiology Unit Languedoc-Roussillon, Montpellier, France. l.king@invs.sante.fr
authors.forename: Lisa A
authors.initials: LA
authors.lastname: King
authors.forename: Laurence
authors.initials: L
authors.lastname: Goirand
authors.forename: Hervé
authors.initials: H
authors.lastname: Tissot-Dupont
authors.forename: Bruno
authors.initials: B
authors.lastname: Giunta
authors.forename: Christine
authors.initials: C
authors.lastname: Giraud
authors.forename: Claude
authors.initials: C
authors.lastname: Colardelle
authors.forename: Véronique
authors.initials: V
authors.lastname: Duquesne
authors.forename: Elodie
authors.initials: E
authors.lastname: Rousset
authors.forename: Michel
authors.initials: M
authors.lastname: Aubert
authors.forename: Richard
authors.initials: R
authors.lastname: Thiéry
authors.forename: Laurence
authors.initials: L
authors.lastname: Calatayud
authors.forename: Gérald
authors.initials: G
authors.lastname: Daurat
authors.forename: Laurent
authors.initials: L
authors.lastname: Hocqueloux
authors.forename: Valérie
authors.initials: V
authors.lastname: Cicchelero
authors.forename: Franck
authors.initials: F
authors.lastname: Golliot
authors.forename: Henriette
authors.initials: H
authors.lastname: de Valk
mesh_terms: D000328:Adult; D000368:Aged; D000383:Agriculture; D000822:Animal Husbandry; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D002417:Cattle; D016997:Coxiella burnetii / Q000276:immunology / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006041:Goats; D006801:Humans; D016015:Logistic Models; D008297:Male; D008372:Manure / Q000382:microbiology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011778:Q Fever / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D012307:Risk Factors; D012621:Seasons; D016036:Seroepidemiologic Studies; D012756:Sheep; D011795:Surveys and Questionnaires
chemical_list: D000907:Antibodies, Bacterial; D008372:Manure